Pandemic unleashes a spike in overdose deaths

The deaths in recent years have largely been attributed to synthetic opioids like fentanyl as the addiction crisis has shifted away from misuse of prescription drugs. In 2018, deaths from methamphetamine spiked 22 percent with states in the West and Midwest seeing the largest increases. Deaths from cocaine have also increased.

The pandemic-fueled uptick in overdose deaths also coincides with the Trump administration’s legal battle to strike down the Affordable Care Act at the Supreme Court. Eliminating the law without a replacement would, among other things, eliminate protections ensuring coverage of benefits including addiction and mental health services.

Experts say undoing the ACA would undermine any efforts to address drug addiction.

The ACA’s Medicaid expansion extended insurance coverage to 1.2 million Americans with substance use disorders, according to an analysis in Health Affairs. Those individuals will lose coverage if the legal challenge prevails.

Carroll disputed the idea that repealing the law would undermine addiction treatment, saying the legal challenge “is not an attempt to take away health care from people.” He added that the Trump administration is “committed to making sure people can get the health care they want,” though he did not provide details about any replacement coverage.

Even under the ACA, behavioral health services are becoming harder to find during the pandemic. A field built around personal interaction has been buffeted by lockdowns and quarantines, forcing providers to scale back services and shift patients to telehealth services. A June survey showed nearly half of these providers estimate they can only survive for six months or less without more emergency funding from federal bailout packages.

Sherry Daley, the senior government affairs director for the California Consortium of Addiction Programs and Professionals, said the addiction crisis has been overshadowed by efforts to help other health providers on the front lines of the pandemic response. She fears her state will also see a dramatic spike in overdose deaths.

“We know it’s coming,” Daley said. There just isn’t a desire at this point to have a strategy to dampen that curve.”

The pandemic has accelerated a trend that CDC data shows was beginning to pick up in 2019.

Preliminary data shows fatal overdoses climbed at least 3 percent for the 12-month period ending in November 2019. Final data will not be available until the end of this year.

Volkow said one noticeable and sustained effect is the rising death rate for all minority groups. Overdose rates for African Americans jumped 20.7 percent in 2018, outpacing any other group. Death rates also increased among Native Americans and Hispanics.

Volkow’s agency is working on an initiative across the federal government to address racial disparities in drug policy, though that work too has been set back by the virus.

“It’s very unfortunate,” said Volkow. “Many programs are on ice. Others are just starting to slowly come back.”

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